Provider Demographics
NPI:1659963924
Name:COLLINS, TIFFANY P (ADMINISTRATOR)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:P
Last Name:COLLINS
Suffix:
Gender:F
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2982 JAMES DR NW
Mailing Address - Street 2:
Mailing Address - City:WESSON
Mailing Address - State:MS
Mailing Address - Zip Code:39191-9613
Mailing Address - Country:US
Mailing Address - Phone:601-919-6294
Mailing Address - Fax:866-982-3424
Practice Address - Street 1:135 E WARREN AVE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-4146
Practice Address - Country:US
Practice Address - Phone:601-919-6294
Practice Address - Fax:866-982-3424
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child